70K veterans still have chance to gain 'retiree' status

By Tom Philpott, Stars & Stripes KoreaDecember 3, 2013

About 70,000 disabled veterans who served on active duty after 9/11, and were medically discharged with disability ratings of 20 percent or less, still have a shot to gain "retiree" status, with base shopping privileges and lifetime eligibility to TRICARE for them and families.

The catch is they have to know about this opportunity and to apply.

Applying is a breeze. Notifying eligible veterans they can apply is the greater challenge. Efforts to reach many of them by mail have been delayed.

To win an upgrade in disability rating, qualified vets don't have to appear before one more medical or physical disability evaluation board. They only have to fill out a short application form, send it to a panel called the Physical Disability Board of Review (PDBR), and wait until the PDBR reviews all relevant health records and decides whether the veteran's parent service did indeed low-ball their original disability rating.

For many years, the Army led the services in tweaking policy and using the VA Schedule for Rating Disabilities in ways that kept ill and injured soldiers from a combined rating of 30 percent or higher to quality for disability retirement. It was less costly to rate a single unfitting condition, ignore others and separate rather than retire soldiers, by awarding ratings of 0, 10 or 20 percent.

In 2008, Congress ordered the services to clean up their disability evaluation systems and end such practices. It also directed the Department of Defense to establish the PDBR with authority to reexamine medical files and, if appropriate, recommend that ratings of vets medically separated from Sept. 11, 2001, to Dec. 31, 2009, be raised to 30 percent or higher.

PDBR applicants don't need to worry about a ratings downgrade. That's prohibited. Yet more than three years after the PDBR began operating, only 6800 veterans have applied for review. Of those, the PDBR has decided 3800, recommending disability upgrade and retiree status for 27 percent. That's down from a rate of 45 percent through 2011.

The services decide whether to accept PDBR recommendations to upgrade a rating to at least 30 percent and allow "retiree" status. Such a re-characterization triggers eligibility for retroactive retired pay back to date of discharge (minus separation pay previously awarded) and full military retiree benefits. TRICARE eligibility also in retroactive so a newly minted retiree able to document out-of-pocket medical costs since time of discharge can files a claim with TRICARE.

Most of 1033 veterans who have won "retiree" status through PDBR review are Army veterans. The top three medical conditions given revised ratings were post-traumatic stress, back ailments and arthritis.

To date, Air Force and Coast Guard authorities have approved every PDBR recommendation. Army has accepted 98 percent of them. The Navy Department, for sailors and Marine applicants, has approved 94 percent.

These "adoption rates" hint at the thoroughness of review work being done by the PDBR three-member panels assigned to review individual medical histories of applicants, said PDBR director James Davis.

"The services are probably not too crazy about having their homework checked. That's what we do," Davis told the Defense Department's Recovering Warrior Task Force on Tuesday, during a briefing on PDBR progress over for the last year.

But if the PDBR ever got negative "pushback" from the services it doesn't any more, Davis suggested. He said three weeks ago a doctor on the Navy Board for the Correction of Military Records told him that when Navy board members are reviewing difficult cases they look to PDBR decisions "as a gold standard," Davis said. "So it's good news about what we do."

What continues to disappoint is the number of applicants. Only eight percent of eligible veterans have applied to PDBR to review their disabilities, a rate that suggests many don't even know the board exists.

The PDBR was born of controversy and, ironically, a fresh controversy in late 2011, over how the Army was rating mental health disabilities, served to sideline plans to notify more eligible veterans about the PDBR.

In January 2012, the PDBR unveiled a plan for a phased mailing of information packets and application forms to every qualified veteran with a current address on file at the VA. The first batch of 15,000 was to be sent to those medically separated in 2001 (post-9/11), 2002 or 2003. Three more mailings, grouped by years of separation, were planned through October 2012 so information on the PDBR would reach almost every veteran discharged a rating of 20 percent or less through 2009.

It didn't happen, however. The VA did a single mailing of 17,2000 packets in May 2012 and then the collaborative outreach effort with PDBR was suspended for 15 months. In June 2012, the PDBR was directed to focus its attention on a special mental health diagnosis review ordered by then-Defense Secretary Leon Panetta. The order came in the wake of allegations that the Madigan Army Medical Center at Fort Lewis, Wash., routinely had modified mental health diagnoses of post-traumatic stress disorder to conditions that resulted in lower disability ratings for soldiers.

That led to the services identifying and mailing letters to every veteran separated from 9/11 through April 30, 2012, who completed a medical evaluation board and during disability evaluation had their PTSD diagnosis or anxiety or depressive disorder diagnosis changed or eliminated.

These special mailings resulted in the services passing on to PDBR almost 940 applications, mostly from soldiers, to review medical records and determine if applicants were disadvantaged by decisions made during their original disability review process.

Finally this fall, VA resumed mailings to disabled veterans eligible for PDBR reviews, sending 20,000 packets to VA addresses for qualified veterans separated through year 2005. More mailings are planned every eight weeks, Davis said, until the effort is complete, presumably sometime next year.

More on the PDBR and how to apply is online at: http://www.health.mil/About_MHS/Organizations/MHS_Offices_and_Programs/pdbr.aspx [2]

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